马克·沙希尔·拉尔是“积极生活斐济”组织的创始人，也是斐济真相与和解委员会的和解专员。他表示：“我的大多数朋友都是通过吸食冰毒感染艾滋病毒的。”他于七月在巴西里约热内卢举行的艾滋病大会上被拍摄。
Mark Shaheel Lal is the founder of Living Positive Fiji and a reconciliation officer for the Fiji Truth and Reconciliation Commission. He says: "The majority of my friends, they got HIV through crystal meth." He was photographed at the AIDS conference in Rio de Janeiro, Brazil, in July.
NPR记者伊恩·谢布布 隐藏字幕 切换字幕 斐济这个岛国素以热带天堂和蜜月胜地闻名，如今却不幸面临两种相互交织的流行病：艾滋病和冰毒成瘾。
Ian Cheibub for NPR hide caption toggle caption Best known as a tropical paradise and honeymoon destination, the island nation of Fiji now has the unfortunate distinction of facing two intertwined epidemics: HIV and addiction to crystal meth.
在2010年至2025年间，斐济的艾滋病病例增长了12倍。九月中旬，斐济政府宣布进入国家紧急状态。据估计，该国现有超过9000例病例；斐济卫生部长宣布，目前每60名成年人中就有1人感染艾滋病病毒。
With HIV cases rising by 12-fold between 2010 and 2025, in mid-September, Fiji's government declared a national emergency. Estimates are that there are upward of 9,000 cases; the country's health minister has announced that 1 in 60 adults are now living with HIV.
在七月于里约举行的2026年艾滋病大会上，领导斐济艾滋病应对工作的公共卫生专家杰森·米切尔将其描述为全球增长最快的艾滋病流行病，并指出三分之二的病例发生在20至34岁的人群中。他说：“我们年轻、活跃、富有生产力的群体目前正在感染艾滋病病毒，除非我们迅速找到解决方案，否则情况将持续恶化。”
At the July AIDS 2026 conference in Rio, Jason Mitchell, a public health specialist leading Fiji's HIV response, described it as the fastest-growing HIV epidemic in the world, noting that two-thirds of cases are in those ages 20-34. "Our young, active, productive population is currently being infected with HIV, and unless we find solutions quickly, this will continue to get worse," he says.
一个关键原因是另一场并行的流行病——该国青年中冰毒滥用的泛滥，他们常常通过注射方式使用。这导致了通过共用针头传播病毒的现象。
A key cause is another parallel epidemic — the rampant use of crystal meth among the nation's youth, who often inject it. That has led to transmission through shared needles.
“我最好的两个朋友去世了，”来自斐济首都苏瓦的25岁艾滋病活动人士马克·拉尔说。“我的大多数朋友都是通过冰毒感染艾滋病毒的。” 冰毒因素 冰毒在斐济早已在一定程度上存在——这些岛屿是已知的大麻从南美洲转运至最终目的地澳大利亚和新西兰的中转站。但自新冠疫情以来，冰毒的使用量激增，斐济的艾滋病专家将此归因于失业率上升与毒品获取途径日益便捷这一致命组合。
"Two of my best friends passed away," says Mark Lal, a 25-year-old HIV activist from Fiji's capital of Suva. "The majority of my friends, they got HIV through crystal meth." The meth factor Crystal meth has long been available to some degree within Fiji — the islands are a known transit hub for the drug between South America and the eventual destinations of Australia and New Zealand. But since COVID, meth use has soared, something Fiji's HIV experts attribute to the lethal combination of rising unemployment and ever more accessible drugs.
“新冠疫情对斐济人民来说是一段艰难的时期，”国家艾滋病防治工作组的医生塞洛西·索科（Sailosi Soqo）表示。“大多数人失去了工作，工时减少，或者被困在家中。与此同时，我们怀疑旅行限制以及边境管控的加强，减少了毒品向目标国家的流动。原本会流向他国的毒品滞留在了斐济，催生了此前并不存在的国内市场。”索科认为，失业率飙升，加上封锁带来的心理健康恶化，导致越来越多的斐济年轻人开始接触冰毒，甚至包括青春期前的儿童。
"COVID was a difficult time for Fijians," says Sailosi Soqo, a doctor working on the national HIV response team. "Most lost their jobs, got less hours or were stuck at home. At the same time, we suspect that the travel restrictions, along with increased border security, decreased the movement of narcotics onto their target countries. Drugs that would otherwise have moved on stayed in Fiji, seeding this domestic market which didn't really exist before." Soqo suggests that spiraling unemployment, combined with worsening mental health due to the impacts of lockdown, led to more young Fijians turning to meth, even preteens. "The communities I work with report children as young as 9 using injectable drugs," he says.
“我所接触的社区报告称，年仅9岁的儿童就开始使用注射类毒品了，”他说。
According to Dashika Balak, a doctor who leads Fiji's national HIV treatment, care and support efforts, the risk of HIV transmission has also been exacerbated by a nationwide shift from smoking meth to injecting it. This includes the so-called "bluetoothing" or "hotspotting" practice where one person injects the drug and then another person injects their blood.
负责斐济全国艾滋病治疗、护理和支持工作的医生达希卡·巴拉克（Dashika Balak）表示，全国范围内从吸食冰毒转向注射冰毒的趋势，也加剧了艾滋病传播的风险。这包括所谓的“蓝牙注射”（bluetoothing）或“热点注射”（hotspotting），即一人注射毒品后，另一人再注射其血液。
According to Dashika Balak, a doctor who leads Fiji's national HIV treatment, care and support efforts, the risk of HIV transmission has also been exacerbated by a nationwide shift from smoking meth to injecting it. This includes the so-called "bluetoothing" or "hotspotting" practice where one person injects the drug and then another person injects their blood.
“蓝牙注射”通常发生在极度贫困的环境中，被视为一种更廉价的致幻方式。但米切尔（Mitchell）认为，它在斐济的流行，部分原因是分享各种物品是当地民族文化的一部分——无论是酒精饮料还是仪式性饮品卡瓦酒，都是通过公共杯子或碗来饮用的；另一部分原因则是针头短缺。索科表示，斐济执法部门为了遏制冰毒使用，严厉打击了针头的获取渠道，他认为这反而无意中助长了“蓝牙注射”的行为。不幸的是，“蓝牙注射”加剧了艾滋病的传播。
Bluetoothing is known to occur in settings of extreme poverty as a cheaper way of getting high. But Mitchell believes that its popularity in Fiji is partially because sharing all manner of things is a part of national culture — both alcohol and the ceremonial drink kava are consumed via a communal glass or bowl — and partially due to a scarcity of needles. Soqo says that law enforcement in Fiji has cracked down on needle availability in an attempt to curb meth use, something that he believes has inadvertently encouraged bluetoothing. Unfortunately, bluetoothing has fueled the spread of HIV. Reports suggest that on average, one infected person in Fiji will pass the virus on to 10 others. "You add the existing culture in Fiji of sharing things, plus the limited access to clean injecting equipment, and you get the perfect storm for HIV transmission," says Soqo.
有报告显示，在斐济，平均一名感染者会将病毒传染给另外10人。“将斐济现有的分享文化，加上难以获得清洁注射器具的情况结合起来，就形成了艾滋病传播的完美风暴，”索科说。
Fiji's HIV epidemic is also spreading in other ways, including risky sexual practices. "What we do know is that sexual intercourse, as a transmission route, made up roughly 50% of the new HIV cases for 2025," says Soqo.
斐济的艾滋病疫情还在以其他方式扩散，其中包括高风险的性行为。索科说：“我们目前掌握的数据显示，2025年新增艾滋病感染病例中，约50%是通过性行为传播的。”
Balak says that low condom use is encouraging the spread of HIV. A 2021 survey found that among 15- to 49-year-olds with multiple sexual partners in the past year, only 24% of men and 9% of women used a condom the last time they had sex. Lal can attest to this — having contracted HIV himself in the summer of 2024 through unprotected sex with a male partner. "You let your guard down once, and boom, it happens," he says.
巴拉克说，安全套使用率低正在助长艾滋病的传播。2021年的一项调查发现，在过去一年有过多个性伴侣的15至49岁人群中，最近一次发生性行为时使用安全套的男性仅占24%，女性仅占9%。拉尔本人就是证明——他于2024年夏天与一名男性伴侣在没有采取保护措施的情况下发生性行为，感染了艾滋病病毒。他说：“你只要放松警惕一次，糟糕的事情就发生了。”防止疫情长期流行病例激增促使大量外国援助涌入，以支持新的艾滋病检测、预防和治疗项目。澳大利亚政府担心感染率上升以及疫情有可能在太平洋地区广泛扩散，于8月宣布了一项价值4800万澳元的新一轮资助计划。澳大利亚政府在一份发给美国国家公共广播电台的声明中表示，政府致力于支持斐济应对艾滋病疫情，防止新增感染、改善早期诊断并扩大治疗可及性。
Preventing a permanent epidemic The surge in cases has led to an influx of foreign aid to support new HIV testing, prevention and treatment programs. Concerned about rising rates of infections and the potential for the epidemic to spwidely through the Pacific, the Australian government announced a new $48 million funding package in August. According to a statement to NPR, the government is committed to supporting Fiji's HIV response to prevent new infections, improve early diagnosis and expand access to treatment. One of the first priorities for Australian organizations working with Fiji is to make HIV testing available at all antenatal clinics. In 2025, 59 babies were born with HIV.
澳大利亚各合作机构在斐济开展工作的首要任务之一，是让所有产前检查门诊都能提供艾滋病病毒检测。2025年，有59名婴儿出生时感染了艾滋病病毒。
"We're trying to get a reliable rollout of these tests so that every single pregnant woman anywhere in the country will be tested for HIV," says Storm Holwill a public health physician working at Melbourne's Peter Doherty Institute for Infection and Immunity. Anyone who is HIV positive would then be placed on viral-suppressing medications known as antiretrovirals to limit the chances of HIV being passed on in utero.
在墨尔本彼得·多赫蒂感染与免疫研究所工作的公共卫生医生斯托姆·霍尔韦尔说：“我们正努力推动这些检测在各地可靠落实，确保全国每一位孕妇都能接受艾滋病病毒检测。”
Blocking new infections on a wider scale is far more challenging. Meth use is most prevalent in some of Fiji's poorest and most vulnerable populations, many of whom have no fixed address. This makes it difficult for medical professionals to test and prescribe treatments.
艾滋病病毒检测呈阳性的人随后将接受被称为抗逆转录病毒药物的病毒抑制药物治疗，以降低艾滋病病毒在宫内传播的可能性。
Blocking new infections on a wider scale is far more challenging. Meth use is most prevalent in some of Fiji's poorest and most vulnerable populations, many of whom have no fixed address. This makes it difficult for medical professionals to test and prescribe treatments.
在大范围内阻止新增感染要困难得多。冰毒的使用在斐济一些最贫困、最脆弱的人群中最为普遍，其中许多人没有固定住所。这给医疗专业人员为这些人进行检测并开具治疗方案带来了困难。
Balak explains that while anywhere between 9,100 and 12,000 people in Fiji are thought to have HIV, only 5,676 of these cases have been officially diagnosed. Even fewer are regularly taking antiretrovirals to keep their condition under control. "Some stop treatment, and some cannot be reached because their contact details are incomplete," she says.
巴拉克解释说，据认为斐济有9,100至12,000名 HIV 感染者，但其中只有5,676例得到正式诊断。定期服用抗逆转录病毒药物以控制病情的人数则更少。
This means that while Australia's aid is providing Fiji with plentiful access to medications such as PrEP pills to block HIV infections, getting these drugs to the right people is not straightforward.
“有些人停止治疗，还有些人因联系方式不完整而无法联系到，”她说。
Dr. Jason Mitchell is the head of Fiji's National HIV Outbreak and Cluster Response Taskforce.
这意味着，尽管澳大利亚的援助使斐济患者能够充足获得PrEP药片等预防HIV感染的药物，但要把这些药物送到正确的人手中并非易事。
"We've just introduced PrEP about two months back," says Mitchell. "The uptake has been very slow, while at the same time, antiretroviral treatment is also freely available, but it's currently sitting on shelves." Lal argues that one of the biggest problems is a lack of awareness. He says many people in Fiji have never heard of these medications. Even for those who have, obtaining them requires a lengthy journey to one of three dedicated clinical centers, either in the cities of Suva and Lautoka or the town of Labasa.
杰森·米切尔博士是斐济全国艾滋病暴发及聚集性事件应对工作组负责人。
"We've just introduced PrEP about two months back," says Mitchell. "The uptake has been very slow, while at the same time, antiretroviral treatment is also freely available, but it's currently sitting on shelves." Lal argues that one of the biggest problems is a lack of awareness. He says many people in Fiji have never heard of these medications. Even for those who have, obtaining them requires a lengthy journey to one of three dedicated clinical centers, either in the cities of Suva and Lautoka or the town of Labasa.
“我们大约两个月前才开始引入PrEP，”米切尔说。“接受和使用进度非常缓慢。与此同时，抗逆转录病毒治疗也可免费获得，但目前这些药物仍摆放在货架上。”拉尔认为，最大的问题之一是缺乏相关认知。他说，斐济许多人从未听说过这些药物。即使是听说过的人，也需要长途跋涉，前往三个专门设置的临床中心之一。这些中心分别位于苏瓦市、劳托卡市或拉巴萨镇。
With Fiji's population spread across more than 100 islands, Lal says that such a journey likely deters many people from seeking care. "If they know the medications are far away, they won't even want to access them," he says. "In a country like ours where religion is big, people would — rather than go — pray and believe that God will heal them." Mobile clinics and clean needles To improve access to PrEP and antiretrovirals, Balak and her colleagues have started creating dedicated HIV response teams in 21 locations across the country. "They will soon be able to order their own antiretrovirals [and] dispense and fully manage their patients on their own," she says.
斐济人口分散在100多个岛屿上，拉尔说，前往外地就医的漫长路程很可能会让许多人放弃治疗。“如果知道药物远在千里之外，他们甚至都不会想要获取药物，”他说。“在像我们这样宗教信仰十分重要的国家，人们与其跋涉前往就医，不如祈祷，相信上帝会治愈他们。”流动诊所和清洁针具 为改善人们获取PrEP和抗逆转录病毒药物的途径，巴拉克和同事已着手在全国21个地点组建专门的艾滋病应对团队。“很快，他们就能够自行订购抗逆转录病毒药物、配发药物，并独立、全面地管理自己的患者，”她说。
With Fiji's population spread across more than 100 islands, Lal says that such a journey likely deters many people from seeking care. "If they know the medications are far away, they won't even want to access them," he says. "In a country like ours where religion is big, people would — rather than go — pray and believe that God will heal them." Mobile clinics and clean needles To improve access to PrEP and antiretrovirals, Balak and her colleagues have started creating dedicated HIV response teams in 21 locations across the country. "They will soon be able to order their own antiretrovirals [and] dispense and fully manage their patients on their own," she says. To track down more people living with HIV, the team is also recruiting and training peer support workers — including some existing meth users who are HIV positive. Balak says she hopes that this could be a way to connect more of the people at most risk of contracting HIV with medical teams.
为了找到更多HIV感染者，该团队还在招募并培训同伴支持人员，其中包括一些已经感染HIV的现有冰毒使用者。巴拉克说，她希望这能成为联系感染HIV风险最高人群与医疗团队的一种方式。
Methamphetamine use remains a tense issue, and some of the proposed schemes to address the spread of HIV have clashed with law enforcement.
冰毒使用仍是一个敏感问题，一些旨在遏制艾滋病传播的方案与执法部门发生了冲突。
To break the chains of infections stemming from contaminated needles, Soqo has proposed supplying thousands of sterile needles and syringes to communities of methamphetamine users. However, Soqo says the government is blocking the plan. "The director prosecutor has told us, 'If you hand these out, we'll arrest you, and we'll charge you for aiding and abetting,'" he says. "As a result, I now have a warehouse full of needles and syringes, just collecting dust." Fiji's government did not respond to a request for comment from NPR.
为了切断由被污染针具引发的感染链，索科提议向冰毒使用者群体提供数千支无菌针具和注射器。然而，索科说政府正在阻止该计划。“主任检察官告诉我们，‘如果你们发放这些物品，我们就会逮捕你们，并以协助犯罪起诉你们，’”他说。“因此，我现在有一整个仓库的针具和注射器，只能落满灰尘。”斐济政府未回应NPR的置评请求。
However, there is more optimism that other approaches could make a significant difference. Fiji is set to receive supplies of the drug lenacapavir, an injectable form of PrEP that provides those at risk of infection due to sexual behavior or drug use near 100% protection from HIV. Because this new preventive drug only needs to be administered twice yearly, Mitchell believes it will be easier to convince people to use it compared with daily pills.
然而，人们更加乐观，认为其他方法可能带来显著改变。斐济即将收到药物来那卡韦的物资。这是一种注射式暴露前预防药物，可为因性行为或吸毒而面临感染风险的人提供接近100%的HIV防护。由于这种新型预防药物每年只需注射两次，米切尔认为，与每日服用药片相比，人们会更容易接受这种用药方式。
To prevent women from contracting HIV from their partners while pregnant, antenatal clinics hope to start offering vaginal rings, which slowly release a protective antiretroviral drug over the course of a month.
为防止女性在怀孕期间从伴侣处感染HIV，产前诊所希望开始提供阴道环。这种阴道环可在一个月内缓慢释放具有保护作用的抗逆转录病毒药物。这些创新迫在眉睫。
Such innovations are badly needed. Projections suggest that if the epidemic continues at its current pace, 25,000 people in Fiji will be living with HIV by 2029, figures that Soqo says would push Fiji's fragile health system to the brink of collapse.
预测显示，如果疫情以目前的速度持续发展，到2029年，斐济将有两万人感染HIV。索科表示，这一数字会使斐济脆弱的医疗体系濒临崩溃。
"Time is not on our side," says Soqo. "With the current numbers, we're already struggling. All our main hospitals are overcrowded and have chronic issues with staffing shortages. Our tuberculosis hospitals and primary healthcare facilities are telling us they're seeing an increase in advanced HIV cases and are overwhelmed. Imagine what things will be like in three years' time. There is an urgent need for more action now." David Cox is a freelance health journalist who has written for publications around the world, including NPR, The New York Times, Wired The Guardian.
索科说：“时间并不站在我们这边。按照目前的病例数量，我们已经难以应对。我们所有主要医院都人满为患，并长期面临人员短缺。我们的结核病医院和基层医疗设施告诉我们，收治的HIV晚期病例正在增加，医疗系统已不堪重负。想象一下三年后的情况会是什么样。现在亟须采取更多行动。”
"Time is not on our side," says Soqo. "With the current numbers, we're already struggling. All our main hospitals are overcrowded and have chronic issues with staffing shortages. Our tuberculosis hospitals and primary healthcare facilities are telling us they're seeing an increase in advanced HIV cases and are overwhelmed. Imagine what things will be like in three years' time. There is an urgent need for more action now." David Cox is a freelance health journalist who has written for publications around the world, including NPR, The New York Times, Wired The Guardian.
戴维·考克斯是一名自由职业健康记者，曾为全球多家媒体撰稿，包括NPR、《纽约时报》、《连线》和《卫报》。他拥有神经科学博士学位。
He has a Ph.D. in neuroscience. For stories about life in our changing world, to NPR's Global Health newsletter. NPR does not offer or accept money for coverage or interviews.
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